Proton pump inhibitors – risk of rare skin condition

Healthcare agencies have reported cases of a rare dermatosis caused by sunlight in patients who are using proton pump inhibitors (PPIs).

The pumps reduce the secretion of stomach acid and are widely used in the management of conditions like acid-reflux and gastric ulcers.

The Medicines and Healthcare products Regulatory Agency (MHRA) has linked the use of PPIs and the development of subacute cutaneous lupus erythematosus, a skin condition that causes scaly plaques or lesions that is usually also accompanied by joint pain.

If a patient treated with a proton pump inhibitor develops lesions—especially in sun-exposed areas of the skin—and it is accompanied by arthralgia:

• advise them to avoid exposing the skin to sunlight
• consider subacute cutaneous lupus erythematosus (SCLE) as a possible diagnosis
• consider stopping use of the PPI unless it is imperative for a serious acid-related condition; a patient who develops SCLE with a particular PPI may be at risk of the same reaction with another
• in most cases, symptoms resolve on PPI withdrawal; topical or systemic steroids might be necessary for treatment of SCLE only if there are no signs of remission after a few weeks or months
• report any suspected side effect with PPIs, or to any medicine, on a Yellow Card.